- Docket No.
- 1:26-cv-02441
- District Court
- District of Columbia
Goal
- Compel agency action
- Declaration that agency action is unlawful
- Vacate agency action
Issues
Litigation Content
Why This Matters:
Why This Matters
A health insurer alleges that the Centers for Medicare & Medicaid Services (CMS) violated the Administrative Procedure Act in declining to recalculate 2026 star ratings for its Medicare Advantage plans. The insurer argues that federal officials must remove 10 measures to be consistent with Clover Insurance Company v. Department of Health and Human Services et al., where a different court held that CMS improperly relied on a total of 20 measures when calculating the star rating for a different Medicare Advantage insurer. Star ratings, which are designed to assess a plan’s quality, affect whether a plan is eligible for the Medicare Advantage program and whether the plan can receive bonus payments.
Potential Impact:
Potential Impact
Challenges to the Medicare Advantage star ratings methodology could undermine the program’s ability to accurately convey quality to consumers and fairly allocate significant financial incentives to health plans, potentially impacting beneficiary benefits and market competition.